F Bernard1, L Troude2, S Isnard3, J-M Lemée4, L M Terrier5, P François6, S Velut7, E Gay8, H-D Fournier9, P-H Roche10. 1. Department of Neurosurgery, CHU Anger, 49100 Angers, France. Electronic address: bernardflorian.bf@gmail.com. 2. Department of Neurosurgery, CHU APHM-Hopital Nord, 13015 Marseille, France. Electronic address: lucas.troude@hotmail.fr. 3. Department of Neurosurgery, CHRU de Grenoble, 38000 Grenoble, France. Electronic address: Stephanie.isnard@live.fr. 4. Department of Neurosurgery, CHU Anger, 49100 Angers, France. Electronic address: Jmlemee@chu-angers.fr. 5. Department of Neurosurgery, CHRU de Tours, 37044 Tours, France. Electronic address: louismarie.terrier@univ-tours.fr. 6. Department of Neurosurgery, CHRU de Tours, 37044 Tours, France. Electronic address: Patrick.francois@univ-tours.fr. 7. Department of Neurosurgery, CHRU de Tours, 37044 Tours, France. Electronic address: stephane.velut@univ-tours.fr. 8. Department of Neurosurgery, CHRU de Grenoble, 38000 Grenoble, France. Electronic address: EGay@chu-grenoble.fr. 9. Department of Neurosurgery, CHU Anger, 49100 Angers, France. Electronic address: hd-fournier@chu-angers.fr. 10. Department of Neurosurgery, CHU APHM-Hopital Nord, 13015 Marseille, France. Electronic address: proche@ap-hm.fr.
Abstract
BACKGROUND: Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. METHODS: A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients' medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. RESULTS: There were 154 patients. The follow-up was 76.8 months on average (range 8-380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. CONCLUSIONS: Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.
BACKGROUND: Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. METHODS: A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients' medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. RESULTS: There were 154 patients. The follow-up was 76.8 months on average (range 8-380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. CONCLUSIONS: Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.
Authors: Lorenzo Giammattei; P di Russo; D Starnoni; T Passeri; M Bruneau; T R Meling; M Berhouma; G Cossu; J F Cornelius; D Paraskevopoulos; I Zazpe; E Jouanneau; L M Cavallo; V Benes; V Seifert; M Tatagiba; H W S Schroeder; T Goto; K Ohata; O Al-Mefty; T Fukushima; M Messerer; R T Daniel; S Froelich Journal: Acta Neurochir (Wien) Date: 2021-03-19 Impact factor: 2.216
Authors: Ciro Mastantuoni; Luigi Maria Cavallo; Felice Esposito; Elena d'Avella; Oreste de Divitiis; Teresa Somma; Andrea Bocchino; Gianluca Lorenzo Fabozzi; Paolo Cappabianca; Domenico Solari Journal: Cancers (Basel) Date: 2022-06-10 Impact factor: 6.575